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This is the Leap Together podcast, where we highlight top leaders driving breakthroughs in clinical research and life sciences.
We learn from things that don't go well. So how we can not repeat those problems. I mean, lot of things we do that don't go well are not in our control, but a lot of them are. And just learning from things that you can do better, smoother is important.
Dr. Gorovoy:That's why you need volume. It's now like I'll do some courses at the annual academies on some special technique. You know, these are techniques that take experience. You can't do it once or twice a year and master it. It's like trying to play golf twice a year and think you're gonna be a scratch golfer.
Dr. Gorovoy:It doesn't happen. And so I I kinda emphasize you need to learn from errors, but you have to have volume so you can catch your errors and and get the skills down. You know? That so that's critical, I think.
Zach:Hi, Zach Gobst. I'm the host of the Lead Together podcast where I speak with leaders in clinical trials and patient advocacy to explore how medical breakthroughs come to life. This episode is brought to you by Leapcure, the leader in patient engagement and recruitment for clinical trials. Leapcure's equitable and empathetic process, accelerates research while empowering patient advocacy. Hundreds of studies and millions of patients across more than 50 countries have used Leapcure.
Zach:The average 62% of study participation visit leapcure.com to learn more. Today's guest is doctor Mark Gorovoy. Doctor Gorovoy is a nationally recognized leader in ophthalmology, over thirty years of experience advancing surgical care for corneal diseases. He's performed thousands of successful procedures and is widely known for helping pioneer, DSAEK, a game changing alternative to full thickness corneal transplants. Doctor Gorovoy has been an active clinical investigator in clinical trials addressing Fuchs Dystrophy and persistent corneal epithelial defects, bringing his latest innovations from research, from the bench directly into his practice.
Zach:His work blends cutting edge technique with deep patient focus, earning him respect not only as a surgeon but as a teacher and early adopter of transformative therapies. I'll just say what stands out to me about doctor Gorovoy is a true practitioner innovator, which is my kind of innovator, and it's clear it comes from a place of doing best by each individual patient, which is a rare combination, and I'm honored to have you on. Doctor Gorboy, thanks so much for being on the show.
Dr. Gorovoy:Zach, thanks for having me. Yeah.
Zach:Yeah, where to begin? I'd like to learn a little bit more about how you got into this space and why. I think we spoke a little bit about it heading into the interview, but for the audience, where did this all start? Where did your journey begin?
Dr. Gorovoy:Going way back when, I am the first physician in my family, so a little bit of groundbreaking in that way. When I was in medical school, you you do in your third and fourth year, you do these rotations where in individual specialties, and, you know, it was easy to eliminate some specialties that didn't appeal to me, but there were so many I could have done and been happy with. How I came to ophthalmology is just circumstance. At the end of the day, I really felt I more comfortable being an expert at a smaller organ than a whole, system. As it turns out, the eye is not just a small little organ.
Dr. Gorovoy:It's very, very complex. But I really thought that it was something I could master, and it also had a surgical component. I really felt very, attracted to something using, you know, doing surgery because the benefits to patients were immediate, as opposed to medical, where it's more of a chronic condition. So, in fact, when I think about it, ophthalmology is one of the few specialties that does both the medical and surgical aspect of that organ system, where we don't have that in most of other medical specialties. You have cardiology, you have cardiothoracic surgeons that kind of divide medical and surgical component.
Dr. Gorovoy:That's true with neurosurgery, urology, and nephrology. I mean, you can go on and on, neuro, neurosurgery, every specialty is divided up. Ophthalmology is probably the one single one that has both surgery and medical. But again, I was naive at that time. I didn't realize what a complex organ in so many systems in one organ.
Dr. Gorovoy:You cannot master them at all. And then it was interesting. How did I become into cornea? Mean, again, you keep dividing down your pathways and that's just kind of circumstantial, you know? When I did my residency, when I stayed where I did medical school in GW and DC, those days were before the match.
Dr. Gorovoy:It was kind of you did an interview, a handshake, and you were good to go. I have kids who are ophthalmologists, and now I see the match, and they're interviewing 20 programs, and it's a big ordeal. Those days, it was, you just went to an interview and did a handshake. But I met a, Doctor. George Stern, who was new on the faculty at George Washington and is hired for the cornea service, and we just struck up a bond.
Dr. Gorovoy:And as it turns out, he left after my first year to relocate to University of Florida. And we kept in touch a little bit. And again, was only four years my senior, but we contacted after I graduated the residency, and I was deciding what to do, a fellowship or going to practice, he invited me to come down there to be his first fellow. So that's where, you know, and that was he was cornea. Like, if I made a relationship with someone who did retina, then I probably would have done retina, right?
Dr. Gorovoy:So it's all personal contacts. I was happy doing a lot of things. I must admit, when I did my internship, I did a surgical internship. Most ophthalmologists do, a medical internship, because I like surgery. And they kept teasing me there, Oh, you wanna be a real doctor?
Dr. Gorovoy:Don't do ophthalmology. They wanna be a neurosurgeon or something like that. So it's all good. I would've been happy doing a lot of things, so I'm happy. And then when I left, finished my fellowship, it's another decision process.
Dr. Gorovoy:People don't realize the complexity that physicians go through in deciding not only what to study, but where to study and what kind of practice, whether you do a group practice, solo, academic, research. I mean, it's just unending choices. And, I was already in Florida. I grew up in New Jersey, outside New York City. And, so it was easy to stay in the state and really go to someplace where I was in need.
Dr. Gorovoy:Notice I was the first cornea anterior segment specialist. I didn't go to a big city like where I trained in DC, where I would have been one of many. So that gave me a lot of opportunities to build a practice, confidence, and, you know, you need confidence and volume to really to get your skill level up and to progress in your field.
Zach:Yeah. With that, you mentioned your family kind of joining the field, and I know you've trained a lot of surgeons. Curious, what's something you try to pass on that's usually not in the textbooks when folks are jumping into ophthalmology?
Dr. Gorovoy:Well, I used to say I've trained hundreds of doctors how to do the SAIC when that first came out, they would come visit me in person in the OR, we would do stuff. Would always start the episode by saying, cause they would watch live surgery, would be part of the training session, and then we would do some practice things in a lab situation. I would say, I hope I have a good day and the surgery goes smooth. You here wanting to learn something, you should hope I have a bad day. Because at the end of the day, we really learn, and it's probably not just surgery, even medicine in general, medical.
Dr. Gorovoy:We learn from things that don't go well. So how we can not repeat those problems. I mean, lot of things we do that don't go well are not in our control, but a lot of them are. And just learning from, I don't wanna say errors, but learning from things that you can do better and things go smoother is important. And that's why you need volume.
Dr. Gorovoy:You know, it's now like I'll do some courses at the annual academies on some special techniques, for example, you know, suturing or securing IOLs of the sclera. And the doctor will take this little course with me at the academy. And, you know, these are techniques that take experience. You can't do it once or twice a year and master it. It's like trying to play golf twice a year and think you're gonna be a scratch golfer.
Dr. Gorovoy:It doesn't happen.
Zach:Yeah.
Dr. Gorovoy:And so I I kinda emphasize you need to learn from errors, but you have to have volume so you can catch your errors and and get the skills down, you know? So that's critical, I think.
Zach:You know, as an early adopter of DSAEK and DSO, what goes through your mind when you're trying something that most others haven't yet?
Dr. Gorovoy:It comes from the experience that potentially new procedure has a lot of benefits, not a little benefit, but a lot of benefits. In the case of DSAEK , we were doing just full thickness PKPs, and I was doing a couple 100 a year. And I would see, and the results were anatomically pretty good, but the real life results were not so good because of all the sutures and astigmatism and then trauma to the eye and the eye was lost. So when I saw some innovative ways to do this surgery without doing all these suturing techniques, jumped on it. And I quickly mastered that in the OR because I had enough volume to do it.
Dr. Gorovoy:And I kind of create, I think my creativity in the OR is kind of my strength. I will think of things to do to make this surgery easier for me. At the end of the day, if it's easier for me, it's easier for the patient. And then eventually, I kind of also having the benefit of being a little bit of a diverse surgeon because I did LASIK, I did cornea, I do glaucoma. I can kind of marry different subspecialties together.
Dr. Gorovoy:So I kind of combined the LASIK and this endothelial transplant technique together to form the DSAEK. The hardest part wasn't convincing people that it was a better way to do DSAEK, but the hard part was getting it out there. You know, going to the company, in this case was Moria, whose equipment I used, and convincing him that this was a game changer. And I had colleagues, Doctor. Price with me and Doctor.
Dr. Gorovoy:Terry was influential. So this is not a solo game here, but getting out there and getting seminars and then teaching people. And there's a lot of doubters. I'll never forget one very well known corneal surgeon with a lot of experience that you're out there promoting this as like a game changer, trying to replace regular transplants, which have a seventy five year history. And you have a one year history.
Dr. Gorovoy:I mean, this is folly. I said, I get that because we, again, I give a talk that's called the Hall of Shame, and there's a lot of things we've done in the past, procedure wise in ophthalmology, that end up being injurious to patients. So, would this be fall into that trap? And I just, I was convinced it was not the case. And, you know, I bet my career on it.
Dr. Gorovoy:But that's the hard part is getting organized to do that. And that takes help. Know, it's not like you just put an A up, come in and learn this procedure. It was a lot harder than it is now. Now we have all these e list services.
Dr. Gorovoy:Like your podcast, you can communicate to a lot of people very quickly. This is pre internet. This was like word-of-mouth and the company send out a blurb in mailings or at a meeting. There was none of this email. It's a game changer, what you have now, where you can communicate.
Zach:Yeah. But I think what I'm hearing, I speak with a number of physicians, your values about positioning the potential benefit the way that it can be and the pursuit of better care. Most folks are conditioned to focus on the risk. Like you said, there were folks that were hard to convince and the risks are there and we have to understand. So, there's a hall of shame of different things that have tried and don't work as well.
Zach:But most people won't drive with the same level of resilience when they're met with that feedback from certain places. It's like, All right, this is no longer my problem, or I can't change their perspective. There's something I don't know if it's your values, don't know if it's your will or how you were taught, but curious because I think there are a lot of folks that once they see something as difficult with something like innovating, they'll kind of stay in their lane. You've kind of pushed past that.
Dr. Gorovoy:Yeah, I mean, this wasn't a little incremental change, that a different suturing technique or a different instrument. This was like monumental change. I mean, this is like, I'm trying to think of an example. I mean, think of like, doing an aortic aneurysm repair, opening up the body to do it versus doing it through a femoral artery, I mean, where there's no incisions. I mean, this is like a game changer type of change of this procedure for this thing.
Dr. Gorovoy:The other thing is, yeah, it is hard. Surgeons specifically, especially when they're seasoned, you know, they're happy with what they're doing. I'm assuming their results are generally what they expect. And it's hard to, the inertia to change and then start over, because now you don't have that experience, you know? Now you're like back in your just training days, and that's a hard thing to accept because there's gonna be a learning curve.
Dr. Gorovoy:I think that's the thing I was trying to emphasize. If you don't do a lot of these, or initially before you've done a lot of these, there's a learning curve. And so not every result is what you want. But in this case, it was such a game changer. And most surgeons pretty adapted.
Dr. Gorovoy:We've been through other stages like this in ophthalmology. The one I remember most, for example, was because I trained early enough before phacoemulsification was established. I mean, trained doing intracap cataract surgery with a cryo probe and leaving the patient afaking with an afaking contact lens. I mean, so to do extra cap and then do phaco, especially I transitioned to phaco, I was already in private practice. That is daunting to take patients.
Dr. Gorovoy:And some of them will ask, Well, how many have you done of these? Or something like that. But you have to say, Boy, but the risk benefit ratio is such a big advantage in this procedure. You have to get on the wagon. Or in this case, if you're a specialist, you would be left behind.
Dr. Gorovoy:If you didn't adapt to phaco, you're not going to be a cataract surgeon, right? If you didn't adapt to these techniques, you're just not going to be in the corneal space anymore. And in the future, I think there'll be other things that will replace this obviously. And that's one thing fun about medicine. It doesn't stagnate.
Dr. Gorovoy:I mean, there's just new ideas every day. It's very invigorating.
Zach:Yeah. Yeah. I think that last point, like we all know science and medicine can move forward, but with you kind of setting yourself up to have a high volume practice, you lean into it rather than try to kind of figure out how do I kind of hold onto the thing I have experience with. You're kind of betting on care improving and being ready to move with it.
Dr. Gorovoy:Yeah, remember I said, it does work for, what's good for me, so to speak, in the OR and post op, is good for the patient. I was taking an operation and speeding it up, And by changing, using the Kerastone Teratome system to do this procedure and not only speeding it up and making it better quality. So it was a no brainer, but before I did that, was doing these manual dissections, which were arduous. Still better for the patient, but not as good for me. And so if I can make myself a better, but more efficient surgeon, it's only gonna benefit the patient.
Dr. Gorovoy:And I think the only claim to doing this with the automated system is that it took it out of the hands of just a couple select high volume corneal surgeons into the mainstream corneal surgeon, because a lot of these original dissections that we had to do to accomplish this were very challenging and weren't gonna be adapted by most surgeons. What I was surprised was how quickly the eye banks got into this space. And now 99% of part of this procedure is really done by the eye bank. Yeah, so it's kind of interesting. It's another whole discussion how they got into this model.
Zach:Curious if there are any, if there's any kind of treatments or technology in eye care right now that more people should be paying attention to, but maybe aren't yet? Anything come to mind?
Dr. Gorovoy:Well, there's a lot of things in the pipeline. For corneal disease, I mean, I think, you know, we're talking about the endothelium, which is typically either a traumatic problem or a genetic problem. Certainly for the genetic problem, there's things out there that I think will eliminate all surgery because they've already got down the genotyping of the different gene defects. And there's ways, and there's companies already looking into this space about correcting that early on. So if you could identify a patient with disease, genetically modify their cells, then we could eliminate the clinical manifestations of disease before they need any procedure.
Dr. Gorovoy:And the cornea is really such a great, I don't want say organ tissue to work with, because not only can we see it, but we have access to the different layers of it Easy. It's not like we have to inject things under the retina or anything. So, so that's really exciting to me and then, of course, they're doing cell cultures that may replace surgery. That's that's coming very quickly. I have some reservations about the limitations of that and the cost.
Dr. Gorovoy:That's the other thing I have problems with is a lot of what we're coming up with is just becoming so costly. I don't know how the system could handle all of this. Kind of reminds me of some of the chemotherapies, which are lifesaving, but the cost to the system is phenomenal. I just don't know how that continues without breaking the bank at some point.
Zach:You spoke a little bit about how practicing in different areas helps with innovation. Interested in kind of the feedback or voice of the patient or what we've noticed from kind of where there's been some sort of patient inspiration for some of the adjustments that you've made. Okay, interested if any kind of examples come to mind of like, an individual patient that kind of changed your view on where we might be able to innovate.
Dr. Gorovoy:Well, yeah, I mean, clearly it was, I mean, would, the benefit to, it's all the benefit to patients, obviously made me a little more efficient. So what does that mean? I could do another case? That's not a critical thing, but it's like, yeah, the patients had, in this case of the transplant to the sake, they said it was game changing. I mean, because a PKP, a regular transplant patient in the old days, could take six months to six years to see well, they had a contact lens they needed.
Dr. Gorovoy:Now they're seeing well in weeks. And who would know the most is patients that were in that transition. Sometimes they had one eye done one way and the other eye done the new way. I mean, it was like night and day, or if they had a family member, because a lot of these are genetic. So, you know, but could just, it's so obvious the advantages in successful cases.
Dr. Gorovoy:Was, you know, now that's not to say every case was successful, obviously, but yeah, it's very obvious very quickly. Just like the safety, again, going to Phaco, you know, making a big incision versus a small incision is a game changer. No different than in surgery doing laparoscopic than open, you know. I, again, I was an in surgical intern. I used to be holding the retractors when they did gallbladder surgery.
Dr. Gorovoy:I mean, it was uncomfortable to me even holding the retractors and now they just do it laparoscopically and the patients go home the same day or something. So these are all just amazing benefits. And it's happening all over medicine. Ophthalmology, I think is the forefront of getting these innovative things quickly. Because it's an organ we have very good access to so easily externally.
Dr. Gorovoy:What's the other game changers that I've been involved with? I mean, LASIK was amazing. Who would predict you can slice the cornea and not get scarring? Just phenomenal changes. There's so many skeptics about that procedure, even now there's naysayers.
Dr. Gorovoy:But let me tell you, game changer procedure. And all the naysayers who are against LASIK or against transplants, I mean, they don't realize the alternative. I tell patients, even today, I will see a patient wearing a contact lens that would get an infection, and they should have had LASIK so they wouldn't have had this problem. So these are technologies that are critically important to the health of eyes. I think there are some cavalier things going on here that we need to be careful about.
Dr. Gorovoy:Having said that, you know, this, so we gotta just make sure we're not entrepreneurial without helping the patient. And we see that in our fields for sure.
Zach:Yeah. Question about kind of like study design and clinical trials. When is a clinical trial designed well versus not? What signals are you getting? Is it patients from the signal or is it stuff that you can typically anticipate?
Zach:And when it's done well, what do you think those ingredients are?
Dr. Gorovoy:Well, first thing for studies, would tell you, it's one thing to say, Oh yeah, that's an interesting drug or technique I'd be interested in helping out. I have patients I think that qualify for that. My experience is it's very difficult, especially in private practice. And even though I do some studies in the private practice world, the paperwork or email work these days is voluminous. It's unbelievable.
Dr. Gorovoy:You have to literally have one or two dedicated study directors just to do a study, even if it involves like five patients over a year. It's that onerous with paperwork and questionnaires. The second thing is for me, it's also difficult to get patients studied because there's a big responsibility for the patient. These studies are done very well, but they're very, lot of patient visits. And so we have to get patients that are local patients.
Dr. Gorovoy:My practice is very regional or even national, so it's hard to get patients. They're not gonna fly in every week just because it's a study thing. And then the hardest part of a study is, you know, most of the good studies do have placebos. So, you have to talk patient into, you know, I am gonna get a placebo. So, those are just challenges recruiting patients and for the practice.
Dr. Gorovoy:But yeah, mean, there are all the studies you've done well that I've been involved with, almost too well, because they're just so tedious. Sometimes I'm trying to figure out where the company is, what's their motive to do this, because some of these are very niche products, but that's great. I mean, we need niche products, obviously. So if you're in an academic setting, it's gonna be, you have a lot more support staff, and that's why a lot of these get done there. And they keep us very isolated from the results, so we don't know what's going on.
Dr. Gorovoy:So it's all interesting, but it's all good. A lot of the studies we do don't go anywhere. And then I did these products and they never came to market three years later. And I thought there was some benefit, but it's hard to tell exactly. There's so many financial things going on in the background.
Zach:I can empathize with sponsors, forest from the trees, and kind of understanding what's going on from the patient perspective or practitioner's perspective. There's a lot that kind of goes into it.
Dr. Gorovoy:I would add that recently it's been, you know, I've been requested to do a couple studies that are basically not medical products, but let's say surgical products. So different designs, whether it's in the glaucoma space or cornea space. They sound good on paper, but I've been doing this so long, some of them are not gonna work. I know they won't work from my experience. And so I declined that, but they still go on because they have people that say, oh, this is interesting and I can make this work and, you know, they'll pay me enough to do it, with the support staff I need.
Dr. Gorovoy:But I just now feel secure enough in what I think is gonna work and not work. So that's a little bit different for me and with my years of experience, yeah.
Zach:Yeah. Last question for you. Is there anyone, if you think of past colleagues or current colleagues, friends, mentors, peers, we'd like to acknowledge or thank for helping you with your journey as an innovator. It's a remarkable path you've taken, and are you still on your way to more, but interested in who comes to mind.
Dr. Gorovoy:Everyone always has to congratulate their wife for putting up with this stuff. I I would go on cruises and I would disappear on a cruise and write a paper, and she didn't know where I was for five hours. But short of that, as I said, the innovators in the endothelial space, really three come to mind. Doctor. Melas, by far, is, I wanna say the brains behind this thought process.
Dr. Gorovoy:And then you got Doctor. Mark Terry and Doctor. Frank Price. Just both very, you know, I just, I can't say enough nice things about them, not only their practice, their personality, they're willing to teach. And, you know, I hope I can, someone will put me in their category.
Dr. Gorovoy:Because at the end of the day, we have these ideas, but the biggest benefit we do is to teaching all the other doctors. You know, these are not, because again, these are, you're out of training, and even we teach the training programs how to do this. So I would, you know, give them a special shout out. In my case, you know, Moria, the company I work with, getting these original seminars where they would invite hundreds of doctors and run it. Obviously, have a financial incentive because we were using our equipment, but they didn't have to do this.
Dr. Gorovoy:I mean, they still had the foresight to say, yeah, this is, you know, gonna be a game changer for them also. And then, to me, I got the best benefit from this because I got to meet all these physicians and surgeons that I never would have met. So now I know colleagues personally, and they'll call me, asking me a question or just, or I get to socialize with them at the meetings. So I get the more benefit than they do, probably, to be honest with you, because that that space is we're a unique group. There's not that many of us and and and I think that's been very valuable to my career.
Dr. Gorovoy:Yeah.
Zach:Amazing.
Dr. Gorovoy:And and I will tell you also, you know, I have I have three children and I just want to acknowledge and two of them are ophthalmologists. So, as I said, I was the first person in my family to be a physician and I have three kids and then three physicians but two of them are in the ophthalmology space and I kind of like to think positive about that, that they must have seen I was happy doing this or bright enough to do what they wanted. And part of that's my wife, I think.
Zach:Beautiful to hear. So it was a pleasure kind of picking your brain and getting your perspective on this stuff. Really excited about, you know, work past, present, and future. Yeah, looking forward to staying in touch, maybe having you on again in the next few years.
Dr. Gorovoy:Oh, my pleasure. Yeah, this phase is just accelerating like all of medicine and, the things that we're talking about now in another five years will be distant memories. I'm predictive of that. Yeah, pleasure. Thanks.
Leapcure:Thank you for joining us on Leap Together. We hope you enjoyed this insightful conversation with Doctor. Mark Gorovoy, a true pioneer in ophthalmology whose dedication to surgical excellence and innovation continues to shape the future of vision care. If today's episode sparked your curiosity or inspired you, be sure to follow Leap Together for more conversations with leaders driving progress in medicine and patient care. Thanks for listening, and until next time, stay informed, stay engaged, and keep pushing for better health outcomes for all.